Effective treatment begins with correct diagnosis. There are two main types of incontinence, each with a number of possible causes:
Stress incontinence is urine leakage that typically happens when laughing, coughing, sneezing, lifting or exercising. It is most commonly caused by weakness of the pelvic floor muscles that surround the bladder, preventing full closure of the urinary sphincter (the valve that controls release of urine). This weakness often results from tissue or nerve damage incurred during childbirth in women and from prostrate surgery in men. Other contributing factors include urinary tract infection, obesity, diabetes and medications.
Urge incontinence is urine leakage that occurs with a strong, sudden need to urinate, even if the bladder is not full. It is typically caused from damage to the nerves or muscles of the bladder, or from a dysfunction in the nervous system as a whole from injury or conditions like multiple sclerosis, Parkinson's disease, Alzheimer's disease, brain tumor or stroke.
Diagnosis begins with a physical exam, often followed by one of more of these common diagnostic tests:
- Cystometry – measures the amount of urine actually in the bladder compared with how full the bladder feels
- Cystoscopy – a visual examination of the inside of the bladder and urinary tract, using a cystoscope (a thin tube with a tiny lens or camera on the end)
- Electromyography – a test that records electrical activity in muscles
- Urinalysis – to check for urinary tract infection
- Uroflowmetry – measures the flow and force of urine stream during urination
There are a number of treatment options for urinary incontinence:
- First treatment options typically include conservative treatments such as medications, dietary changes and pelvic muscle (Kegel) exercises, as well as management devices such as pessaries for women and penile clamps for men
- Physical therapy can include gentle, hands-on techniques to help associated organs, soft tissues and joints function in a more coordinated manner
- InterStim® therapy involves implanting an electronic device that acts like a pacemaker for the bladder
- Surgical options uses a narrow strip of natural or synthetic material inside the pelvic area to support the bladder neck and the urethra (the tube that carries urine from the bladder)
- BOTOX® injections across the bladder muscle can prevent involuntary bladder contractions
